Occupational injury is a prevalent problem among workers providing Personal Assistance Services (PAS). We are conducting a survey that will document work-related injuries (e.g., musculoskeletal disorders), days of work lost because of these injuries, workers' perceptions about the factors that may have contributed to these injuries, how worker injury may contribute to worker turnover, and health care use (including worker's compensation) associated with these occupational injuries. A companion survey of PAS recipients is also being conducted. It will document recipient injuries (e.g., fractures, sprains), potentially preventable adverse events (e.g., unintended weight loss, bed sores, contractures, medication mismanagement), and recipients' perception of the extent to which these events are associated with inadequate PAS assistance, or a consequence arising when PAS providers are unavailable due to work-related injury or illness. Occupational injury in PAS is expected to increase as more of this assistance is obtained through consumer directed models of care. In this mode PAS workers are "independent providers," meaning they are hired, directed, and fired by individual PAS recipients. The worker is not employed, trained, or supervised by an agency. The knowledge sought and its eventual application (such as training, case management, ergonomic improvements, and other interventions designed to reduce the incidence of preventable problems among both PAS providers and recipients) is consistent with the priorities of the National Institute for Occupational Safety & Health, and several priorities of NIOSH's National Occupational Research Agenda (NORA), including those related to traumatic injuries and back and musculoskeletal disorders, the social consequences of those injuries and disorders, and special populations such as low wage workers. The project is a state-wide survey of PAS providers and recipients in California's In Home Supportive Services program (IHSS). This program serves more than 320,000 recipients per month and employs more than 280,000 PAS providers. The sample will be limited to PAS providers who are working with adult PAS recipients (i.e., age 18 or older) who have two or more limitations in activities of daily living (i.e., bathing, dressing, transferring in/out of beds or chairs, toileting, and eating). The inclusion criteria select PAS providers working with recipients who may have or are approaching eligibility for nursing home placement. [unreadable] [unreadable] [unreadable]